| Doctor Name: | MS. BONNIE L CLARK |
| NPI Number: | 1063563310 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | WHNP-BC |
| License Number: | CNP81695 |
| Business Practice Address: | 5 Silver Rdg Veazie, ME - 044017086 |
| Business Phone Number: | 2079420824 |
| Business Fax Number: | 2079420824 |
| Mailing Address: | 5 Silver Rdg, VEAZIE |
| State: | ME |
| Postal Code: | 044017086 |
| Phone Number: | 2079420824 |
| Fax Number: | 2079420824 |
| NPI Enumeration Date: | 01/15/2007 |
| NPI Last Update Date: | 06/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | CNP81695 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |